Key result
Depression severity had the strongest negative impact on health-related quality of life (b: -0.3 to -0.7), alongside multimorbidity and age, collectively explaining 27% to 55% of the variance in primary care patients with chronic systolic heart failure.
Cross-Sectional (n=318)
Yes
Depression severity and multimorbidity are major determinants of impaired health-related quality of life in primary care patients with chronic systolic heart failure.
Depression severity may warrant screening in systolic HF; leaves open whether treatment improves health-related quality of life.
BACKGROUND: Identifying the determinants of health-related quality of life (HRQOL) in patients with systolic heart failure (CHF) is rare in primary care; studies often lack a defined sample, a comprehensive set of variables and clear HRQOL outcomes. Our aim was to explore the impactof such a set of variables on generic and disease-specific HRQOL. METHODS: In a cross-sectional study, we evaluated data from 318 eligible patients. HRQOL measures used were the SF-36 (Physical/Mental Component Summary, PCS/MCS) and four domains of the KCCQ (Functional status, Quality of life, Self efficacy, Social limitation). Potential determinants (instruments) included socio-demographical variables (age, sex, socio-economic status: SES), clinical (e.g. NYHA class, LVEF, NT-proBNP levels, multimorbidity (CIRS-G)), depression (PHQ-9), behavioural (EHFScBs and prescribing) and provider (e.g. list size of and number. of GPs in practice) variables. We performed linear (mixed) regression modelling accounting for clustering. RESULTS: Patients were predominantly male (71.4%), had a mean age of 69.0 (SD: 10.4) years, 12.9% had major depression, according to PHQ-9. Across the final regression models, eleven determinants explained 27% to 55% of variance (frequency across models, lowest/highest β): Depression (6×, -0.3/-0.7); age (4×, -0.1/-0.2); multimorbidity (4×, 0.1); list size (2×, -0.2); SES (2×, 0.1/0.2); and each of the following once: no. of GPs per practice, NYHA class, COPD, history of CABG surgery, aldosterone antagonist medication and Self-care (0.1/-0.2/-0.2/0.1/-0.1/-0.2). CONCLUSIONS: HRQOL was determined by a variety of established individual variables. Additionally the presence of multimorbidity burden, behavioural (self-care) and provider determinants may influence clinicians in tailoring care to individual patients and highlight future research priorities.
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Peters-Klimm et al. (2010) conducted a cross-sectional in Chronic systolic heart failure (n=318). Patient- and provider-related determinants (e.g., depression, multimorbidity, age) was evaluated on Generic and disease-specific health-related quality of life (SF-36 and KCCQ). Depression severity had the strongest negative impact on health-related quality of life (b: -0.3 to -0.7), alongside multimorbidity and age, collectively explaining 27% to 55% of the variance in primary care patients with chronic systolic heart failure.
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